As global smallpox epidemics became headlines, Dr. Antoine Clutier-Ble’s clinic in Montreal began accepting patients with unusual – and often painful – bodily lesions.
Until the beginning of June, the family doctor and his colleagues had treated about 15 patients with confirmed infections, out of approximately 100 laboratory-confirmed cases reported so far in Quebec. People with suspected infections soon began showing up at the clinic almost every day.
Cloutier-Blais began to notice some interesting trends.
The measles lesions, he found, did not look exactly like what he had seen in photos circulating online of people infected in parts of Africa where the virus had been found for decades.
“The lesions are much smaller and usually very localized,” he said, adding that there is “a very wide range of different types of presentations.”
In some cases, the lesions appear on or inside various parts of the body, including the mouth, genitals or anal area of patients, sometimes spread to the limbs or torso or pop up all over the body.
But for other patients, the visible symptoms were much more subtle – even just one trace on the skin.
Medical experts in many countries have noticed similar patterns. In this unprecedented outbreak – which offers many global clinicians their first real-world experience with the disease – there is a clear range in severity, from classic rashes all over the body requiring hospital stays and painkillers to cases of monkeypox. as a mild infection that can be easily missed or confused with other conditions.
And while these infections are usually treatable, there is a growing concern that the virus may spread to vulnerable populations at higher risk of life-threatening disease.
The rash may be the first warning sign
Clinical photographs show monkey lesions in patients in the United Kingdom during a global outbreak of cases outside the typical endemic regions of the virus in Africa. (United Kingdom Health Security Agency)
Monkeypox often manifests as a flu-like illness, characterized by symptoms such as fever, chills, and muscle stiffness that may precede treacherous lesions.
However, for recent patients in the United States, the appearance of a rash is often the first warning sign that they are ill.
“In these new cases, what we hear is that these [pre-rash] the symptoms may be really mild or not even noticeable at all, “said Dr. Agam Rao, a medical officer at the Centers for Disease Control and Prevention in the United States. during an interview with a medical journal JAMA.
For clinicians unfamiliar with the virus, it may also be difficult to distinguish some monkeypox infections from chickenpox – or some sexually transmitted infections such as herpes and syphilis.
“Monkeypox can be disguised as other conditions,” said Dr. Rosamund Lewis, a Canadian physician and technical director at the World Health Organization (WHO), about the smallpox outbreak.
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Body lesions associated with the virus are commonly thought to begin around the head before progressing down to the arms and legs, but Rao said U.S. patients first experienced rashes in the genital or perianal regions, including some people who have suffered from inflammation of the rectum.
One case published in the medical journal Infectious Diseases Eurosurveillance examines the experience of an HIV-positive man in his 30s who was diagnosed with monkeypox in May after traveling and having sexual activity in Europe.
The man’s initial symptoms were painless pustules on his penis, which soon worsened. The lesions became painful and itchy, then the man developed a fever three days later, with the rash spreading to his torso, face and limbs in the following days, necessitating two trips to his doctor and a short hospital stay.
“On examination at the hospital, the lesions of the penis have largely formed scabs, and the lesions on the hands and lower extremities are painless papular pustules,” the authors of the case wrote.
“Monkeypox can affect anyone”
It is not known that monkeypox is a sexually transmitted infection, but it can be spread through various forms of close contact with other people. This includes skin-to-skin contact, even if someone has minimal lesions in their genital regions, or through respiratory droplets, if someone has a lesion in their mouth, said Louis from the WHO.
Although there have been some reports of women who have recently become infected around the world, most of the infections in this global epidemic – now about 1,000 confirmed and in number – have been among men who have sex with men, causing awareness campaigns by and for members of this community.
“Of course, monkeypox can affect anyone, any gender, any sexual orientation,” said Dane Griffiths, director of the Ontario Gay Sexual Alliance, which has reported about a dozen cases, mostly in Toronto.
“But given the current cases we see and the issues that are unresolved about the dynamics of monkeypox transmission in our community, we are informing people about it.
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Cloutier-Blais stressed the importance of rapid community mobilization, including “impressive” participation in monkey vaccination clinics in Montreal.
Since its launch in late May, more than 1,600 doses have been given to members of the public who may be at higher risk of contracting monkeypox due to sexual contact or work-related causes.
“Everyone can end up experiencing symptoms,” Clutier-Ble said.
As global smallpox epidemics became headlines, Dr. Antoine Clutier-Ble’s clinic in Montreal began accepting patients with unusual – and often painful – bodily lesions. (Guillaume Steben / CBC News)
“Stay isolated” if lesions appear
When it comes to minor cases, the doctor from Montreal said that his patients do not need much medical care.
“We just offer people to cover their lesions and stay isolated as much as possible, with a mask if they have to meet other people, and otherwise stay home and cover their lesions until they are completely healed. “He explained.
However, more serious cases require hospitalization, with patients experiencing “very severe fever or pain that is difficult to control with oral medication alone.”
No one has died so far during this recent global outbreak outside Africa, WHO Director-General Tedros Gebreyesus told a news conference on Wednesday. But the disease can be deadly in some cases, especially for at-risk groups such as pregnant women, children and people with compromised immune systems.
Tedros called on the countries to make serious efforts to stop the further transmission of the virus in order to prevent monkeypox from spreading more widely and spreading to these vulnerable populations.
“The risk of monkeypox settling in non-endemic countries is real,” he said.
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